[Part III: free periosteal flaps as a treatment for mandibular osteoradionecrosis].
BACKGROUND
The vascularized periosteal free flap transposes a non-irradiated soft tissue with neo-angiogenesis, bone induction, and osteogenesis qualities. Its technique and interest are studied for early osteoradionecrosis.


METHODS
A retrospective study was made between 1992 and 2002. Thirty-four patients were selected among the 59 cases operated for osteoradionecrosis; all patients were classified stage II and I on the Epstein scale. Twenty-six patients were reconstructed using a non-periosteum free flap (bone, muscular or cutaneous flap), and eight patients were reconstructed using a "periosteum free flap". The study was clinical, radiological, and histological.


RESULTS
Osteoradionecrosis evolved for two of the eight patients having undergone periosteum free flap surgery. Operative morbidity and the number of reoperation were less important than for the rest of the series. The reconstruction was satisfactory on a functional and esthetic level. A bone production was noted for two patients of the "periosteum" group.


CONCLUSIONS
Periosteum free flap surgery is an alternative for early osteoradionecrosis. The periosteum brings osteo-induction and osteogenesis, and revascularization recorded clinically, radiologically, and histologically, even on an irradiated area.
d'Hauthuille
C
C
Service de Chirurgie Maxillofaciale et Stomatologie, CHU de Nantes, Place Alexis-Ricordeau, Nantes, France. Cedric@dhauthuille.net
Testelin
S
S
Taha
F
F
Bitar
G
G
Devauchelle
B
B
D001861:Bone Regeneration; D016371:Cranial Irradiation / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008336:Mandibular Diseases / Q000209:etiology / Q000601:surgery*; D055806:Microvessels; D018919:Neovascularization, Physiologic; D019647:Oral Surgical Procedures / Q000379:methods*; D010025:Osteoradionecrosis / Q000209:etiology / Q000601:surgery*; D010521:Periosteum / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome